Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

{"title":"Measuring the effects of facial regional changes following excessive aesthetic treatments—A survey and eye-tracking-based investigation","authors":"Joanna Kempa ,&nbsp;Anna Kasielska-Trojan ,&nbsp;Bogusław Antoszewski ,&nbsp;Rod J. Rohrich ,&nbsp;Ting-Song Lim ,&nbsp;Mikaela V. Cotofana ,&nbsp;Michael Alfertshofer ,&nbsp;Sebastian Cotofana","doi":"10.1016/j.bjps.2025.04.027","DOIUrl":"10.1016/j.bjps.2025.04.027","url":null,"abstract":"<div><h3>Background</h3><div>The increasing popularity of minimally invasive soft tissue filler injections has been accompanied by a significant rise in filler reversal procedures, highlighting the concerns regarding adverse effects, including the facial overfilled syndrome (FOS). This trend suggests a growing need to understand individual facial regions contributing to FOS and their influence on patient perception.</div></div><div><h3>Objective</h3><div>To investigate the influence of exaggerated volumization of facial regions on the perceptions of attractiveness and gender traits using eye-tracking and survey methods to better understand FOS.</div></div><div><h3>Methods</h3><div>A total of 50 volunteers (30 women and 20 men) rated frontal images of different modified facial regions (<em>i.e</em>., eyes, cheeks, and lips) and the combination thereof on 5-point Likert scales for attractiveness, unattractiveness, masculinity, and femininity. Their gaze patterns and eye movements were analyzed using eye-tracking technology.</div></div><div><h3>Results</h3><div>Elevating the lateral canthal angle sharply reduces the attractiveness in male and female faces. Accentuating the zygomatic arch generally decreases attractiveness and masculinity, particularly in men, while slightly increasing femininity. Lip volumization in women marginally increases attractiveness without significantly altering femininity. In combined modifications, the decrease in attractiveness is predominantly driven by the eye modification aspect, leading to the most substantial decline in the perceived attractiveness and gender-specific traits.</div></div><div><h3>Conclusion</h3><div>Certain facial modifications such as lip enhancement may increase attractiveness, while cheek enhancements may increase femininity. However, most alterations, particularly those involving the eyes or combinations of treatments, generally decrease attractiveness and impact the perceptions of femininity and masculinity. This underscores the need for balanced aesthetic treatments to prevent overcorrection.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 270-280"},"PeriodicalIF":2.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world data on efficacy and safety of 1256 consecutive ultrasound-guided percutaneous carpal tunnel release","authors":"Jules Descamps ,&nbsp;Guillaume Draznieks ,&nbsp;Rémy Nizard ,&nbsp;Pierre-Alban Bouché ,&nbsp;Thomas Apard","doi":"10.1016/j.bjps.2025.04.029","DOIUrl":"10.1016/j.bjps.2025.04.029","url":null,"abstract":"<div><h3>Purpose</h3><div>Carpal tunnel syndrome (CTS) is a prevalent condition requiring effective and safe treatment options. This study evaluated the efficacy and safety of ultrasound-guided carpal tunnel release (UCTR) in routine clinical practice. Furthermore, we assessed UCTR outcomes in terms of symptom resolution, patient satisfaction, and complication rates using real-world data extracted via a natural language processing model.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on 926 patients who underwent 1256 UCTR procedures between November 2018 and May 2024. Primary outcomes included the resolution of paresthesia and pain, and secondary outcomes involved strength restoration and patient satisfaction. Complication rates were assessed to evaluate safety. Data accuracy and precision were validated through standardized methods.</div></div><div><h3>Results</h3><div>Post-UCTR, significant symptom improvement was observed, with paresthesia rates decreasing from 99% (620/626) to 8.5% (79/926) and pain rates from 96% (654/926) to 9% (83/926). Strength restoration was noted, and 95.8% (628/926) of patients reported positive results with the procedure. Safety was demonstrated by a low complication rate of 0.7% (10/1256). Validation demonstrated data accuracy of 96.3% and precision of 100%.</div></div><div><h3>Conclusion</h3><div>UCTR is a highly effective and safe intervention for CTS that delivers substantial symptom relief, high patient satisfaction, and minimal risk. These findings support the adoption of UCTR in clinical practice. Further prospective studies are recommended to confirm these results and investigate long-term outcomes.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 11-18"},"PeriodicalIF":2.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence prediction model for readmission after DIEP flap breast reconstruction based on NSQIP data","authors":"Berk B. Ozmen ,&nbsp;Diwakar Phuyal ,&nbsp;Ibrahim Berber ,&nbsp;Graham S. Schwarz","doi":"10.1016/j.bjps.2025.04.028","DOIUrl":"10.1016/j.bjps.2025.04.028","url":null,"abstract":"<div><h3>Background</h3><div>Readmissions following deep inferior epigastric perforator (DIEP) flap breast reconstruction represent a significant healthcare burden, yet current risk prediction methods lack precision in identifying high-risk patients. We developed a machine learning model to predict 30-day readmission risk using a large national surgical quality database.</div></div><div><h3>Methods</h3><div>This retrospective analysis examined 13,312 DIEP flap procedures from the American College of Surgeons National Surgical Quality Improvement Program database (2016–2022). A stacked machine learning model was developed incorporating patient demographics, comorbidities, operative characteristics, and laboratory values. Model performance was assessed using accuracy, precision, recall, and F1 score.</div></div><div><h3>Results</h3><div>The overall readmission rate was 5.42% (723 patients). The stacked model achieved 88% accuracy and 79% recall for readmission prediction with an area under the receiver operating characteristic curve of 0.8921 (95% CI: 0.853–0.927) on the test set. Key predictors included days from operation until superficial incisional surgical site infection complications, operative time, body mass index, and preoperative albumin.</div></div><div><h3>Conclusion</h3><div>This stacked machine learning approach demonstrates strong predictive capability for post-DIEP flap readmissions, with high sensitivity for identifying at-risk patients. The model’s performance suggests clinical utility in preoperative risk stratification and resource allocation. Implementation could enable targeted intervention strategies to potentially reduce readmission rates in high-risk populations.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"106 ","pages":"Pages 1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Google Gemini’s AI generated responses to questions after breast reconstruction","authors":"Aaron N. Hendizadeh ,&nbsp;Nicholas Schmitz ,&nbsp;Annie Fritsch ,&nbsp;Lauren Martin ,&nbsp;Jaime Pardo Palau ,&nbsp;Christodoulos Kaoutzanis ,&nbsp;Mamtha Raj ,&nbsp;David E. Kurlander ,&nbsp;Darren Nin ,&nbsp;George Kokosis","doi":"10.1016/j.bjps.2025.04.021","DOIUrl":"10.1016/j.bjps.2025.04.021","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to evaluate Google Gemini’s responses to common post-operative questions pertaining to breast reconstruction surgery.</div></div><div><h3>Methods</h3><div>Google Gemini AI was prompted with 14 common post-operative questions related to breast reconstruction surgery. Four experienced breast reconstructive surgeons and four advanced practice providers (APPs) evaluated the responses for accuracy, completeness, relevance, and overall quality on a 4-point Likert scale. Median scores were calculated and utilized as the final score. Responses were further categorized as accurate vs inaccurate, complete vs incomplete, relevant vs irrelevant, and high vs low quality. Readability was evaluated using the Fleisch-Kincaid reading scale.</div></div><div><h3>Results</h3><div>Attending surgeons classified 12/14 responses (86%) as accurate, 12/14 (86%) as complete, 13/14 (93%) as relevant, and 12/14 (86%) as high quality. APPs rated 11/14 responses (79%) as accurate, 12/14 (86%) as complete, 14 /14 (100%) as relevant, and 10/14 (71%) as high quality. APPs assigned lower median scores for overall quality than physicians (p=0.003). The mean Flesch-Kincaid readability score was 52.3.</div></div><div><h3>Conclusion</h3><div>Google Gemini provided relevant and complete responses to common post-operative questions pertaining to breast reconstruction. The “fairly difficult” readability score may pose challenges for certain patient populations. Differences in scores between physicians and APPs for “overall quality” may be due to higher levels of experience among physicians, allowing them to evaluate answers in a broader context. While Google Gemini demonstrates potential as a tool for patient education, patients should be advised to consult with clinicians for the most reliable and personalized medical advice.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 185-188"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Divergent effects of vitamin D3 on human dermal fibroblasts and keratinocytes in wound repair: Implications for therapeutic targeting in tissue remodelling and scarring","authors":"Jing Qin Tay ,&nbsp;Kirsten Riches-Suman ,&nbsp;Anne M. Graham ,&nbsp;Ajay L. Mahajan ,&nbsp;M. Julie Thornton","doi":"10.1016/j.bjps.2025.04.019","DOIUrl":"10.1016/j.bjps.2025.04.019","url":null,"abstract":"<div><h3>Background</h3><div>Vitamin D is known to regulate inflammation and immunity, suggesting it may play a role in wound healing. However, its mechanism of action in key skin cell types—keratinocytes and fibroblasts—involved in wound repair is poorly understood.</div></div><div><h3>Objectives</h3><div>This study aimed to elucidate the impact of vitamin D₃ and its precursors on keratinocyte and fibroblast behaviour during wound healing using human <em>ex vivo</em> skin explant and primary cell culture models.</div></div><div><h3>Methods</h3><div>The rate of closure of incisional wounds made on human <em>ex vivo</em> skin explants treated with the vitamin D₃ precursor, cholecalciferol, or the active form 1,25(OH)₂D₃ was measured over 6 days in culture. Primary cultures of human keratinocytes and dermal fibroblasts were propagated from female facial skin, and changes in gene expression and physiological responses to cholecalciferol or 1,25(OH)₂D₃ were assessed using various techniques, including scratch wound assays, quantitative reverse transcription polymerase chain reaction, zymography, and immunocytochemistry.</div></div><div><h3>Results</h3><div>1,25(OH)₂D₃ significantly increased the early wound closure rate in <em>ex vivo</em> human skin explants, while cholecalciferol had no effect. 1,25(OH)₂D₃ accelerated keratinocyte migration but inhibited fibroblast migration and their transition into pro-fibrotic myofibroblasts, reducing extracellular matrix remodelling. Using small interfering RNA, it was established that responses were mediated by vitamin D receptor signalling.</div></div><div><h3>Conclusions</h3><div>This study highlighted the divergent effects of vitamin D on keratinocyte and fibroblast wound responses, i.e., promoting re-epithelialisation, while potentially suppressing aberrant fibrosis. Optimising vitamin D status may facilitate wound repair while minimising scarring, which has implications for treating non-healing wounds and excessive scarring disorders.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 323-335"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainability in breast surgery: An eco-audit of the breast implant pathway","authors":"Zahra Ahmed ,&nbsp;Alexander Zargaran ,&nbsp;Davina Marudamuthu ,&nbsp;Sara Sousi ,&nbsp;David Zargaran ,&nbsp;Stephen Hamilton ,&nbsp;Afshin Mosahebi","doi":"10.1016/j.bjps.2025.04.020","DOIUrl":"10.1016/j.bjps.2025.04.020","url":null,"abstract":"<div><h3>Background</h3><div>Breast implants are the most common type of breast reconstruction performed globally. However, despite the vast number performed annually, the environmental impact of the pathway has yet to be evaluated.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 34 immediate breast implant reconstructions at a single reconstructive centre was performed. Process mapping and life-cycle analyses were performed for equipment, staff, patients, and land. A carbon dioxide equivalent was used to estimate the relative contributions of the initial consultation, preoperative, intraoperative, and immediate postoperative periods.</div></div><div><h3>Results</h3><div>This study estimated the carbon footprint of a patient undergoing immediate reconstructive breast implant surgery to be approximately 48.80 kgCO₂eq. The majority of emissions came from the intraoperative period (28.58 kgCO₂eq., 58.57%). Production and transport of surgical and anaesthetic equipment had the highest overall contribution to the carbon footprint (25.46 kgCO₂eq., 52.17% overall). Patient travel was the second greatest contributor, closely followed by anaesthesia (18.28% and 16.60%, respectively).</div></div><div><h3>Conclusions</h3><div>This is the first study to estimate the carbon footprint of the breast implant pathway. Strategies to mitigate the impact of carbon emissions include the reuse of equipment. The impact of revisional procedures and future breast implant exchanges was not included and should be factored into future estimates of carbon footprint calculations.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 219-229"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining the abdominal wall perforasome with clinical application","authors":"Joshua Meyerov ,&nbsp;Rachna Ram ,&nbsp;Damien Grinsell","doi":"10.1016/j.bjps.2025.04.024","DOIUrl":"10.1016/j.bjps.2025.04.024","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Perforator selection is critical during operative planning for deep inferior epigastric artery perforator (DIEP) flap reconstruction. This study aimed to evaluate the anatomical variations in deep inferior epigastric artery (DIEA) perforators and their primary subcutaneous branching patterns within the perforasome, using three-dimensional computed tomography angiography (CTA) to develop a new nomenclature system.</div></div><div><h3>Methods</h3><div>Abdominal CTA scans of 180 patients undergoing preoperative imaging for DIEP flap reconstruction were evaluated. Maximum intensity projection (MIP) and volume-rendering technique (VRT) reconstructions were used to map perforator anatomy. Branching patterns were correlated to the location and subcutaneous course of the perforators, at emergence from the anterior rectus sheath.</div></div><div><h3>Results</h3><div>Perforators were classified into 3 main categories and further sub-classified based on the orientation of tributaries. Type I perforators were the most common (87.2%) and coursed as a single trunk (IA) or bifurcated with an internal angle ≤30° (IB). Type II perforators (7.5%) bifurcated at 180 ± 20° (IIA) or between 30° and 160° (IIB). Type III perforators (5.3%) produced 3 or more primary branches. On an average, there were 2.9 ± 1.6 perforators per hemi-abdomen. Larger caliber vessels were found closer to the umbilicus (P &lt; 0.005). Most perforators (80.5%) exited the rectus sheath caudal to the umbilicus and coursed in an inferolateral direction.</div></div><div><h3>Conclusions</h3><div>This study provides a novel classification of the primary subcutaneous perforasome branching patterns of DIEA perforators and highlights the clinical implications for improved flap design and operative outcomes.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 283-291"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143917445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using ChatGPT to write a literature review on autologous fat grafting","authors":"Kate Manley,&nbsp;Sophia Salingaros,&nbsp;Abby Chopoorian Fuchsman,&nbsp;Xue Dong,&nbsp;Jason A. Spector","doi":"10.1016/j.bjps.2025.04.015","DOIUrl":"10.1016/j.bjps.2025.04.015","url":null,"abstract":"<div><h3>Background</h3><div>ChatGPT is a large language model (LLM) that has been proposed as a scientific writing tool, though its ethical use remains a highly debated topic within the academic community. This article defines the strengths and weaknesses of ChatGPT in writing a plastic surgery literature review and describes proper methodologies for optimizing GPT-generated output.</div></div><div><h3>Methods</h3><div>ChatGPT-4o was prompted to brainstorm topics for a literature review on plastic surgery. Autologous fat grafting was chosen and ChatGPT generated each section of the literature review with citations, which were subsequently evaluated for accuracy. The ability of medical professionals to discriminate between a ChatGPT-generated and published fat grafting abstract was assessed.</div></div><div><h3>Results</h3><div>ChatGPT successfully conceived and performed a literature review on autologous fat grafting. The model performed well in outline creation, article summarization, and editing content. It generated a professional review of fat grafting, though its claims were generalized, not completely factual, and lacked accurate citations. ChatGPT provided 21 citations, 5 of which correctly referenced a real article. Eight contained errors in their publication details, such as publication dates and author lists. The remaining 8 were unable to be found in PubMed (hallucinated). Medical professionals were unable to distinguish ChatGPT-generated material from a published abstract.</div></div><div><h3>Conclusions</h3><div>With appropriate vigilance, ChatGPT may be cautiously used as a writing assistant throughout the literature review process; however, authors must verify all scientific claims and citations. ChatGPT’s greatest limitation remains its tendency to hallucinate, which undermines the reliability of a generated manuscript and perpetuates inaccurate information.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 292-304"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143917446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical validation of a novel risk assessment score for prediction of unplanned reoperations and readmissions in hand surgery","authors":"Olachi O. Oleru,&nbsp;Nargiz Seyidova,&nbsp;Jamie Frost,&nbsp;Niklas H. Koehne,&nbsp;Prabhjot Singh,&nbsp;Peter J. Taub","doi":"10.1016/j.bjps.2025.04.013","DOIUrl":"10.1016/j.bjps.2025.04.013","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 123-125"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor site in anterolateral thigh (ALT) free flaps: A systematic review of closure techniques and introduction of a management algorithm","authors":"Chad Chang ,&nbsp;Ivan Rodriguez-Mantilla ,&nbsp;Andrés Camilo Herrera ,&nbsp;Luis Arturo Molina ,&nbsp;Giuseppe Antonio D’Amico ,&nbsp;Juan Enrique Berner ,&nbsp;Marco Marcasciano ,&nbsp;Hung-Chi Chen","doi":"10.1016/j.bjps.2025.04.008","DOIUrl":"10.1016/j.bjps.2025.04.008","url":null,"abstract":"<div><div>The anterolateral thigh (ALT) free flap is widely used in reconstructive microsurgery for its versatility and reliability, yet donor site management becomes challenging when flap dimensions exceed those for tension-free primary closure. The flap width-to-thigh circumference ratio (FW/TCR) is a potentially valuable objective decision-making tool. Given the heterogeneity of the reported closure techniques, this review aimed to map current techniques, identify gaps in evidence and propose a FW/TCR-based algorithm to standardise ALT donor site closure.</div><div>A review of PubMed/MEDLINE, EMBASE, Cochrane Library and AMED databases was conducted from inception to October 2023, including English-language studies focused on ALT donor site closures. Data on closure techniques, outcomes, and complications were extracted.</div><div>Overall, 27 studies met the inclusion criteria, describing direct primary closure, locoregional flaps, skin grafting, and adjunctive methods such as negative pressure wound therapy, acellular dermal matrices and tissue expansion. Direct primary closure was generally reported as feasible for FW/TCR &lt; 16%. Once FW/TCR exceeded 30%, skin grafting or alternative solutions such as ‘kiss’ (split skin paddle) flaps were more frequently described. In the intermediate range (16–30%), locoregional flaps were commonly employed to avoid graft-related morbidity.</div><div>Drawing on these findings, we propose a FW/TCR-based algorithm: (1) direct closure for FW/TCR &lt; 16%, (2) locoregional flaps for FW/TCR 16–30%, and (3) grafting or alternative techniques if FW/TCR exceeds 30%. Standardising closure strategies using these thresholds may reduce donor site morbidity and optimise patient outcomes. Further high-level comparative studies are necessary to validate and refine these recommendations.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"105 ","pages":"Pages 243-259"},"PeriodicalIF":2.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}